Author
Topic: Billers to Claims Ratio (Read 3958 times)

I am the new claims department manager for a healthcare provider that sends out approximately 45,000 claims per month. (yes, that is correct 45 thousand CNS 1500 claim forms per month).

The AR is in a shambles because they seem to be under the impression that their current staff should be able to handle this kind of volume. (they means = executive level management – and please note that this company has only been billing their services to insurance carriers for the past 4 years – their service was just recently deemed a covered service by Medicare in 2008).

Their current AR equals a total of more than 119,000,000 claim lines and their 1500 claim form usually consist of a single claim line but the initial claim will consist of 2 claim lines. Their total AR is over 16MIL.

This is what I have for staff:4 Leads – 2 are very experienced 2 are not7 AR Follow-up staff members8 Staff members that solely print out claims and any back-up documents that need to be attached to initial claims that are sent to the primary carriers in addition to printing all of the claims and EOBs going out to the secondary carriers.5 Cash Posters and 6 additional cash posters who are temps (but turn over in the temp positions are high).

The majority of the staff are novices, i.e. this is their first medical billig job. Most started out as temps and were convert to FTE after 6 months of service (they did not have to pass any skill level tests whatsoever)

The only claims that go electronically are primary claims to Aetna and Medicare.

The billing system they use was designed for a small sized business, which they were 4 1/2 years ago and it is extremely labor intensive.

Example: Claims have to be manually queued up to print. All payments have to be posted manually. This system cannot even generate a valid Aging Report.

We are moving to over to much better billing system in March but the 16M+ AR will remain on the old system and we will have to try to capture as much of that revenue as we can. Obviously, there are hundreds of claims that are written off due to late filing or failure to file appeals within the required time limits. There are probably hundreds of claims that have never been worked.

Please, I need help from anyone who can give it. IMO I need to hire at least 26 additional staff members in order to handle the volume of claims that we generate. The "powers that be" keep telling me that I have to find some sort proof to substantiate the need to increase the size of my staff. They might go for some sort of industry accepted formula that will calculate how many FT AR Follow-up Representatives it would take to manage this kind of volume.

Perhaps even a solid resource from which to gather this kind of statistical data or several professional opinions from established high profiled sources to back up my claim that they are seriously understaffed.

It really is hard to say your understaffed because you state these billers are novices and were not properly screened, with that said your problems could JUST lie in the current staff and their lack of experience. That's not to say I can say that even if all were experienced you would not have same problems. I'm saying that it might behoove the practice to start there in making changes. Hiring and training more experienced staff and getting rid of dead weight, would be an excellent start.

Thank you for your input but it sounds like I should have qualified my question a little bit better. For the sake of argument and in an attempt to clarify the situation I am in, let's look at this another way.

If I could everybody to answer the following questions perhaps this will help to prove my point to the company.

We have approximately 59,000 claims on our aging AR that need to be worked. Considering that the timely filing limits vary depending on the primary insurance carrier, in your professional opinions, how many qualified AR follow-up staff members is it going take to not only follow up on these aging claims but to also follow-up on the new claims that will be added to AR in the ocming months?

Even as experienced as I am, I don't think it is physically possible to work more than 60 accounts per day. That is a total of 8 accounts per hour or one account every 7.5 minutes.This equals a monthly total of 157.5 accounts per employee. I have 7 AR Follow up staff,which means, if they do nothing else but work the Aging AR, they will only be to work 1,105.5 per month.Now, do you see where I am coming from. It is virtually impossible for them to 59,000 account in over a period of a couple of months.

The way I see it, we have to hire more staff, otherwise it is going to get so bad that employees are going to just up and quit, walk out. The pressure that is currently being laid upon them to increase their production and to increase their performance is rediculously unfair.

I agree with Linda. So if I am understanding this right, you want to hire 26 more extra people. (most likely they will not be trained as per your expectations) so you will have to train them. so as Linda stated, why not train your staff that you already have, maybe even take a saturday training. Do you know 26 experienced people that not only can you hire in such a brief timeframe but you would want working under you. The staff you have may need some "tweeking" and maybe some moving around in the office, but you already have them, they know this system as of now....I dont fully understand your opinion. When you get the new system, you will have the same previous 24 staffers & another 26 new hires to retrain. IMO-I will keep to myself.

Well, if they don't want to hire more people, how about suggesting Overtime for the special project at hand. Have the employees work overtime and foicus on the old stuff and during normal working hours work on the new stuff.